AFL 21-50 From the California Department of Public Health
December 8, 2021
TO: Primary Care Clinics (PCC)
General Acute Care Hospitals (GACH)
SUBJECT: Assembly Bill (AB) 789 – Testing for Hepatitis B and Hepatitis C
All Facilities Letter (AFL) Summary
This AFL notifies all PCCs and GACHs of the chaptering of AB 789 (Chapter 470, Statutes of 2021), requiring the facility to offer screening tests for hepatitis B and hepatitis C to all adults receiving primary care from the health care facility.
Effective January 1, 2022, AB 789 requires all primary care providers to offer screening tests for hepatitis B and hepatitis C to adults receiving primary care, to the extent these services are covered under the patient’s health insurance, consistent with U.S. Preventive Services Task Force recommendations. The offering of the screening tests is required to be culturally and linguistically appropriate.
Hepatitis B screening tests include any laboratory tests or tests that detect the presence of hepatitis B surface antigen (HBsAg) and provides confirmation of whether the patient has a chronic hepatitis B infection. Hepatitis C screening tests include any laboratory screening test or tests that detect the presence of hepatitis C virus antibodies in the blood and provides confirmation of whether the patient has ever been infected with the hepatitis C virus. Hepatitis C diagnostic tests include any laboratory test or tests that detect the presence of the hepatitis C virus in the blood and provides confirmation of whether the patient has an active hepatitis C virus infection.
This bill provides exemptions from testing requirements if the patient:
- is being treated for a life-threatening emergency.
- is being treated in a hospital’s emergency department.
- has previously been offered or has been the subject of a screening test for hepatitis B or hepatitis C, unless the health care provider determines that one or both of the screening tests should be offered again.
- lacks capacity to consent to a hepatitis B screening test or hepatitis C screening test, or both.
If the patient accepts the screening test offer, the health care provider is required to offer follow-up care to the patient, or refer the patient to a health care provider who can provide that care if the screening test for hepatitis B is positive for hepatitis B surface antigen (HBsAg), or the screening test for hepatitis C antibody is positive (reactive).
Follow-up care is defined for these purposes as medical management and antiviral treatment for chronic hepatitis B or hepatitis C according to the latest national clinical practice guidelines recommended by the American Association for the Study of Liver Diseases. The follow-up health care for a positive hepatitis C antibody screening test must include a HCV RNA test to diagnose active infection.
CDPH’s failure to expressly notify facilities of statutory or regulatory requirements does not relieve facilities of their responsibility for following all laws and regulations. Facilities should refer to the full text of all applicable sections of the Health and Safety Code.
If you have any questions or concerns regarding this AFL, please contact your local district office.
Original signed by Cassie Dunham
Acting Deputy Director
- U.S. Preventive Services Task Force A and B Rated Recommendations
- CDPH Hepatitis B and Hepatitis C Screening Toolkit for Primary Care Providers (updated version pending)
- CDC Viral Hepatitis Resource Center (fact sheets for health care providers and patients)
- Interpretation of Hepatitis B Serologic Test Results
- Recommended Testing Sequence for Identifying Hepatitis C Virus (HCV) Infection
- Interpretation of Results of Tests for Hepatitis C Virus (HCV) Infection and Further Actions
- Hepatitis B Management: Guidance for the Primary Care Provider
- Hepatitis C Online
- Association for the Advanced Study of Liver Diseases Practice Guidelines
- Project ECHO